It has long been recognized that chronic renal failure (CRF) in children is associated with growth delay. Still In our days nevertheless, growth retardation remains today a major impediment to the full rehabilitation of children with CRF. The reduction of in height velocity frequently results in diminished final adult height. Available evidence suggests that growth retardation might be the result of late referral and/or suboptimal clinical care in children with CRF. Management of malnutrition, renal osteodystrophy, metabolic acidosis, salt wasting and anemia should be optimal before recombinant human growth hormone initiation.